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Are you concerned that your newborn is ill or has a fever?
A fever in a young infant (<2 months of age) can be a serious infection. If your infant feels warm or isn't acting well, unbundle them and check their temperature.
What is the best way to check an infants temperature?
A Rectal temperature is the most accurate temperature. A temperature of 100.4 F or greater is a fever.
My infant has a fever, what do I do next?
If your infant has a fever (temperature >100.4) and is less than 2 months of age, consider bypassing the pediatricians office and heading straight to the Emergency Department (preferably a Pediatric Emergency Department) for an evaluation. Most of the time, the fevers are secondary to self limiting viruses. However, in a young infant it is very important to rule out the serious bacterial infections that they are more susceptible to. Some of the concerning bacterial infections are Sepsis (infection in the blood stream), Urinary Tract Infection, Pneumonia, or even Meningitis (inflammation/swelling of the protective membranes covering the brain and spinal cord, this can be from either virus for bacteria).
What should I expect them to do to my infant at the Emergency Room?
At the emergency room, be prepared to have multiple tests and procedures done. Some of the tests performed may include, but are not limited to basic lab work/blood draws (checking electrolytes, blood counts, obtaining blood culture, placing an IV), imaging (chest x-ray or other), urine analysis (using a catheter to obtain the urine is the the correct and sterile way to evaluate for urine infection) and possibly a lumbar puncture (obtaining cerebral spinal fluid from the lower back)
Why do they need to do a Lumbar Puncture?
One of the most serious infections in a young infant is meningitis, and a lumbar puncture is the only procedure that allows us to evaluate the cerebral spinal fluid for infection. It is very important to have done, especially if your infant is ill appearing, has a fever without a known source of infection, and if it is recommended by the emergency room physicians. This is also usually done prior to starting antibiotic therapy.
These are a lot of tests and procedures. Do I really need to have these tests done and give my child antibiotics if we can't find the source of the fever or infection?
The short answer is yes. This can be overwhelming and difficult for parents as well. Know that it is necessary and very important to rule out serious bacterial infections in a young infant. The younger the infant (< 30 days of age), the more likely they need a very thorough workup and antibiotic therapy. I would highly recommend following the advice of the emergency room physicians or your pediatrician. Although some of the labs obtained will help guide the physicians decision making, most serious bacterial infections are identified through cultures which take 24-48 hrs to produce results (reveal if their is an infection). The consequences of untreated bacterial infections in infants are very serious and can ultimately result in death. Therefore, the risk of not doing a thorough evaluation and/or treating the infant when necessary is very serious and is not advised.
What happens after all of the labs and tests have been done?
If there is any concern for possible bacterial infection, your child will require antibiotic therapy immediately, therefore your child may be required to stay overnight in the hospital. They will likely remain on antibiotics while they rule out these serious infections (especially if your infant is <30 days old). If your infant is >30 days of age, appear well and/or if they have a source (not a serious infection) identified for the fever, you may be able to be discharged home with close follow-up. This all depends on the emergency room physicians evaluation and recommendations. I work as a pediatric hospitalist, we are the physicians caring for your infant after the initial work-up has been done. We will monitor all of the labs/cultures and decide when it is safe to discontinue antibiotic therapy and/or discharge your infant home.
Will every emergency room do this work up on my baby if they have a fever?
Remember, medicine is always evolving, therefore a different approach for evaluation of a fever in a young infant may be taken for your child depending on the emergency department/hospital your infant is brought to. There is not just one right way to approach a neonate baby with a fever, but this is commonly what to expect.